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Topic: NV vs SD just for grins (Read 4074 times)

Assuming a purchase price of a truck and travel trailer in NV at $75000.00Clark county (Las Vegas) sale tax rate 8.3% equals just shy of $6225.00 for both units.

NV registration fees assuming a 2017 truck MSRP (that's how they figure it....NOT the actual sales price)of $50000.00 using an online estimate is $909.NV travel trailer registration based on 25000 MSRP is $466.00Total upfront fees before you have cooked one slice of bacon in the new rig is a whopping $7600.00

SD sales tax rate is 4%. A $75000.00 T/TT rig would set you back $3000.00 in sales taxesSD truck registration would be $144.00SD TT registration would be $108.00

NV $7600 vs SD $3250Four thousand three hundred fifty difference.

Having to drop the Medicare Advantage at 0.00 monthly premiums (over that for part "B") in NV and taking on a Medigap policy using my personal attributes was from $120 to $140 a month.A Medigap policy does not have "network" provisions.....it can be used at any doctor or hospital nationwide.(or so I was told)

Assuming the median price of a Medigap policy of $130.00 a month, one could pay that premium for 33 months with the savings in the tax and registration fees in NV.

What I'm finding very strange is this note at the bottom of the page:If you use out-of-network providers under this plan, you may have to pay more or even full price. Out of Network care doesn't count towards your deductible and maximum out-of-pocket.

Uh? I thought a BCBS PPO plan would pay for medical expenses even for out-of-network providers?!

I believe I'm making some serious mistake here, and will be grateful if someone can set me straight.

Uh? I thought a BCBS PPO plan would pay for medical expenses even for out-of-network providers?!

I believe I'm making some serious mistake here, and will be grateful if someone can set me straight.

Thanks in advance, -- Vall.

A PPO plan is ONLY the ability to choose your own doctor or hospital within a preferred provider network or organization.Provider "organization" is the key wording.

Contrast this with a HMO......you choose upfront, a doctor from a list of insurer provided practitioners and that doctor is stamped directly on the insurance ID card. This is the only PRIMARY doctor you can see and be assured of full plan premium coverage.The insurance provider also dictates which hospital you can go to in order to stay within the plan's provisions and not pay any "non-preferred" up charges.

If you go outside that HMO or a PPO, to get treatment, say from Clark county (Las Vegas, Pahrump) to Washoe (Reno area) one is not within that "network" or "organization" that insurers have negotiated with a block of medical providers.

Note how every plan wants you to state upfront, and before any quotes are offered....enter a zip code.What one block of medical providers have negotiated in the Las Vegas zips, other providers in a Reno zip MAY have not.

I believe doing due diligence and making a phone call to the plan providers and asking this specific question would be prudent."If I have Clark county as my home address, can I get plan coverage in Washoe county, or any locality I am in at the time, at the same cost or are there "out of network" up charges"?

Personally, I have resigned myself to just "plan" on routine doctor visits and be in my "network" at that time or take out a Medigap policy and ditch the Medicare Advantage plan.Medigap policies do not have the "network" restrictions.

One thing I have found out during research of all this is......United Health Care has what they call a "passport" plan which allows a person to get medical care out of network, without the up charges. This passport plan delineates what counties and in what states participate, and at this time, those counties are very limited.There are a few hoops to jump, a person has to call UHC and tell them when and where you plan to be out of "network" and for what duration of time.Costs for this passport plan necessitates a phone call also......premiums don't just jump out on the screen.I had a lengthy (75 minute) phone call to a UHC representative who was beyond belief helpful.....she even dug up the list of states and their counties which participate in the passport program.I have that list if anyone might be interested.

It all boils down to how much are you willing to pony up for monthly premiums. A HMO is the least costly and often no additional premiums are due, and if you want the freedom to see any doctor you want, within a delineated network, a PPO is going to make you pay for that freedom.

Caveat:....don't take an anonymous internet poster, on an internet forum as the gospel.

Having to drop the Medicare Advantage at 0.00 monthly premiums (over that for part "B") in NV and taking on a Medigap policy using my personal attributes was from $120 to $140 a month.A Medigap policy does not have "network" provisions.....it can be used at any doctor or hospital nationwide.(or so I was told)

Yes, a Medigap supplement such as a "Plan F" will cover absolutely all the costs that Medicare doesn't pay. We have a Plan F and had no medical costs other than prescriptions last year.

However, you would need to ALSO have a Medicare Part D prescription drug plan which will cost you another ~$40-60/mo. Your Medicare Advantage plan covered both medical and drugs, without it you need two separate policies.

A PPO plan is ONLY the ability to choose your own doctor or hospital within a preferred provider network or organization.Provider "organization" is the key wording.

Contrast this with a HMO......you choose upfront, a doctor from a list of insurer provided practitioners and that doctor is stamped directly on the insurance ID card. This is the only PRIMARY doctor you can see and be assured of full plan premium coverage. The insurance provider also dictates which hospital you can go to in order to stay within the plan's provisions and not pay any "non-preferred" up charges.

That's not true with Kaiser. My primary care physicians name is not on my membership card. I am also free to change my doctor whenever I want and go to any of the various medical facilities in the area.

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It all boils down to how much are you willing to pony up for monthly premiums. A HMO is the least costly and often no additional premiums are due, and if you want the freedom to see any doctor you want, within a delineated network, a PPO is going to make you pay for that freedom.

An HMO and PPO are very similar. Primary difference is ownership. Kaiser is a Corporation and owns it's facilities. It's doctors are for the most part employees, and while I'm guessing, are under contract as opposed to having a typical employer employee relationship. A PPO network is a group of individual doctors and hospitals who are organized by and under contract with an administrator. They have agreed to fee schedules determined by the administrator.

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Caveat:....don't take an anonymous internet poster, on an internet forum as the gospel.

Couldn't agree more.

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Gary B1st

2005 Pace Arrow 35G2016 Jeep Wrangler

Poverty exists not because we cannot feed the poor, but because we cannot satisfy the rich.

What I'm finding very strange is this note at the bottom of the page:If you use out-of-network providers under this plan, you may have to pay more or even full price. Out of Network care doesn't count towards your deductible and maximum out-of-pocket.

Uh? I thought a BCBS PPO plan would pay for medical expenses even for out-of-network providers?!

I believe I'm making some serious mistake here, and will be grateful if someone can set me straight.

Thanks in advance, -- Vall.

The point of a PPO is to contain costs. They negotiate with providers who agree to charge patients based on a fee schedule. That's how they contain their costs. If you are treated outside the PPO, you do two things. First you cause the PPO to do additional work since they need to make sure the non-PPO-doc is treating and charging within their guidelines. There's a cost associated with that effort. Second, if you go outside the network and incur costs over and above what the PPO would normally cover, you defeat the purpose and benefit of a PPO. They can't allow that and stay in business.

With regard to your last comment "I believe I'm making some serious mistake here", You are indeed. Remember there are no free rides. And everything is not always what it seems. Caveat Emptor. Let the buyer beware. You are the buyer. You are the one who needs to beware.

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Gary B1st

2005 Pace Arrow 35G2016 Jeep Wrangler

Poverty exists not because we cannot feed the poor, but because we cannot satisfy the rich.

Thanks for the great explanations. Seems I'm even more ignorant on the subject of US Health Insurance than I thought I was!

I will make sure to study this more closely and talk to health insurance brokers and question the insurance companies themselves before making any decision (we're still 1 1/2 year from moving into the full-time lifestyle, so it's all just "advanced planning" for now)

I went ahead and checked the coverage, as I was expecting (from what I've read here in this forum and elsewhere), this BCBS PPO plan had great coverage out-of-state (at least in the places I checked), much better than the best HMO and EPO plans I was able to find at the Escapees Livingston, TX and Bushnell, FL ZIP codes.

Vall, it is an impossible conundrum, IMO. You really have to nail down your situation and then figure out which scenario works best for you - it is highly unlikely to be "ideal". State income tax can be a pretty significant issue, obviously health care is. Remember that there are "alternatives" to "Obamacare" (including private insurance and opting out (either pay the penalty or meet one of the exemptions)).

Vall, it is an impossible conundrum, IMO. You really have to nail down your situation and then figure out which scenario works best for you - it is highly unlikely to be "ideal".

Yep, I understand that... it will surely be a compromise.

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State income tax can be a pretty significant issue, obviously health care is. Remember that there are "alternatives" to "Obamacare" (including private insurance and opting out (either pay the penalty or meet one of the exemptions)).

Sure thing. Right now I'm checking mainly Obamacare because we are going to need health insurance anyway -- so I think it will probably be best to chose one of the "Exchange" plans. I'm also reading up on health care sharing ministries, and will surely check the private insurance options.

My main point in the above post is: what are we should be checking for measuring a domicile option, besides health insurance costs, personal income taxes, vehicle sales tax and registration costs, and mail forwarding service? Is there anything I've forget, and/or am I making some mistake in my estimations?

IMO, it varies from person to person. There are often benefits for state residents that may or may not be of benefit to you. Kids and in-state college tuition, state parks (annual pass), maybe even whether the state is red/blue. Some states require you to have your vehicles inspected in the state once every year, some don't. A few states (about ten) require an "enhanced" drivers license for bigger/heavier rigs, many do not (for recreational/RV use). There are probably dozen's of possible factors, I'm sure I'm not thinking of all of them.